Tuesday, November 6, 2012

Hip resurfacing revisions vs total hip revisions vs partial hip revisions: what are the differences in the outcomes?


2012 Nov;470(11):3134-41. doi: 10.1007/s11999-012-2498-x.

Do revised hip resurfacing arthroplasties lead to outcomes comparable to those of primary and revised total hip arthroplasties?

Source

Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Room W1646, Box 502, Ottawa, ON, K1H 8L6, Canada.

Abstract

BACKGROUND:

A theoretical clinical advantage of hip resurfacing (HR) is the preservation of femoral bone. HR femoral component revision reportedly yields postoperative function comparable to that of primary THA[total hip artheroplasty.]  However, few studies have looked at the outcome of both HR femoral and acetabular side revisions.

QUESTIONS/PURPOSES:

We determined whether (1) patients undergoing HR revision to THA have perioperative measures and outcome scores comparable to those of patients undergoing primary THA or revision of primary THA and (2) patients undergoing HR revision of both components have perioperative measures and outcome scores comparable to those of patients undergoing HR revision of the femoral component only.

METHODS:

We retrospectively reviewed and compared 22 patients undergoing revision HR to a THA to a matched (age, sex, BMI) group of 23 patients undergoing primary THA and 12 patients undergoing primary THA revision. Patients completed the WOMAC and SF-12 questionnaires before surgery and at latest followup (range, 24-84 months for HR revision, 28-48 months for primary THA, and 24-48 months for revision THA). Blood loss, days in hospital, complications, and outcome scores were compared among groups.

RESULTS:

We observed no differences in SF-12 scores but observed lower WOMAC stiffness, function, and total scores in the HR revision group than in the primary THA group. Patients undergoing HR revision of both components had comparable SF-12 and WOMAC stiffness, function, and total scores but overall lower WOMAC pain scores compared to patients undergoing HR revision of the femoral side only. The HR revision group had greater intraoperative blood loss compared to the primary THA group but not the revision THA group.

CONCLUSIONS:

The perioperative measures and outcome scores of HR revision are comparable to those of revision THA but not primary THA. Longer followup is required to determine whether these differences persist. Patients undergoing HR revision of one or both components can expect comparable stiffness and function.

xxxxxxx

Primary total hip artheroplasty -Single stage total hip replacement which replaces both the femoral head and the acetablum

hemaiarthroplasty-half a hip replacement which replaces only the fem

Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head

2nd article is of similar interest:


2010 Jun 11;340:c2332. doi: 10.1136/bmj.c2332.

Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review.

Source

DePuy International, Leeds LS11 8DT. chopley@its.jnj.com

Abstract

OBJECTIVE:

To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients.

DESIGN:

Systematic review and meta-analysis of randomised trials, quasirandomised trials, and cohort studies.

DATA SOURCES:

Medline, Embase, Cochrane register of controlled trials, publishers' databases, and manual search of bibliographies.

STUDY SELECTION:

Randomised controlled trials, quasirandomised trials, and cohort studies (retrospective and prospective) comparing hemiarthroplasty with total hip arthroplasty for treating displaced femoral neck fractures in patients aged more than 60 years.

DATA EXTRACTION:

Relative risks, risk differences, and mean differences from each trial, aggregated using random effects models. Analyses were stratified for experimental and non-experimental designs, and two way sensitivity analyses and tests for interaction were done to assess the influence of various criteria of methodological quality on pooled estimates.

DATA SYNTHESIS:

3821 references were identified. Of the 202 full papers inspected, 15 were included (four randomised controlled trials, three quasirandomised trials, and eight retrospective cohort studies, totalling 1890 patients). Meta-analysis of 14 studies showed a lower risk of reoperation after total hip arthroplasty compared with hemiarthroplasty (relative risk 0.57, 95% confidence interval 0.34 to 0.96, risk difference 4.4%, 95% confidence interval 0.2% to 8.5%), although this effect was mainly driven by investigations without concealed treatment allocation. Total hip arthroplasty consistently showed better ratings in the Harris hip score (three studies, 246 patients, weighted mean difference 5.4, 95% confidence interval 2.7 to 8.2) after follow-up periods of 12 to 48 months. The standardised mean difference of different scores from five studies was 0.42 (95% confidence interval 0.24 to 0.61), indicating a medium functional advantage of total hip arthroplasty over hemiarthroplasty. Total hip arthroplasty was associated with a slightly higher risk of dislocation (relative risk 1.48, 95% confidence interval 0.89 to 2.46) and general complications (1.14, 0.87 to 1.48).

CONCLUSION:

Single stage total hip arthroplasty may lead to lower reoperation rates and better functional outcomes compared with hemiarthroplasty in older patients with displaced femoral neck fractures. However, heterogeneity across the available trials and distinct subgroup effects preclude definitive statements and require further research in this area.

No comments:

Post a Comment